Skip to main content

Advertisement

SpringerLink
Log in

Ventilation/perfusion ratio and right to left shunt in healthy newborn infants

  • Original Research
  • Published:
Journal of Clinical Monitoring and Computing Aims and scope Submit manuscript

Abstract

Oxygenation impairment can be assessed non-invasively by determining the degree of right-to-left shunt and ventilation/perfusion (VA/Q) inequality. These indices have been used in sick newborn infants, but normative values have not been reported which are essential to determine the magnitude of the abnormality. We, therefore, aimed to measure the shunt and VA/Q in infants with no history of respiratory conditions and determine if there was any effect of supine or prone position and the reproducibility of the data. Data were analysed from infants who had undergone a hypoxic challenge and in a subset who had been assessed in the supine or prone position. Transcutaneous oxygen saturations (SpO2) were recorded at fractions of inspired oxygen (FIO2) of 0.21 and 0.15. Two independent raters used a computer software algorithm which analysed and fitted paired data for FIO2 and SpO2 and derived a curve which represented the best fit for each infant’s data and calculated the shunt and VA/Q. The raters ability to interpret the SpO2 value which corresponded to a given FIO2 was compared. The downwards displacement of the FIO2 versus SpO2 curve was used to estimate the degree of right-to-left shunt and the rightwards shift of the curve was used to calculate the VA/Q ratio. The mean (SD) gestational age of the 145 infants was 39 (1.6) weeks, their birth weight was 2990 (578) gms and median (range) postnatal age at measurement 3 (1–8) days. The mean (SD) VA/Q ratio was 0.95 (0.21). None of the infants had a right-to-left shunt. No significant differences were found in VA/Q in the supine compared to the prone position. The intraclass correlation coefficient of VA/Q between two independent raters was 0.968 (95% CI 0.947–0.980), p < 0.001. Right-to-left shunt and VA/Q ratio in healthy newborn infants were similar in the prone compared to the supine position.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Kinsella JP, Greenough A, Abman SH. Bronchopulmonary dysplasia. Lancet. 2006;367(9520):1421–31.

    Article  PubMed  Google Scholar 

  2. Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med. 2001;163(7):1723–9.

    Article  CAS  PubMed  Google Scholar 

  3. Smith HL, Jones JG. Non-invasive assessment of shunt and ventilation/perfusion ratio in neonates with pulmonary failure. Arch Dis Child Fetal Neonatal Ed. 2001;85(2):F127–32.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Bamat N, Ghavam S, Liu Y, DeMauro SB, Jensen EA, Roberts R, et al. Reliability of a Noninvasive Measure of V./Q. Mismatch for Bronchopulmonary Dysplasia. Ann Am Thorac Soc. 2015;12(5):727–33.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Dassios T, Curley A, Morley C, Ross-Russell R. Using Measurements of Shunt and Ventilation-to-Perfusion Ratio to Quantify the Severity of Bronchopulmonary Dysplasia. Neonatology. 2015;107(4):283–8.

    Article  PubMed  Google Scholar 

  6. Quine D, Wong CM, Boyle EM, Jones JG, Stenson BJ. Non-invasive measurement of reduced ventilation:perfusion ratio and shunt in infants with bronchopulmonary dysplasia: a physiological definition of the disease. Arch Dis Child Fetal Neonatal Ed. 2006;91(6):F409–14.

    Article  Google Scholar 

  7. Roe PG, Jones JG. Analysis of factors which affect the relationship between inspired oxygen partial pressure and arterial oxygen saturation. Br J Anaesth. 1993;71(4):488–94.

    Article  CAS  PubMed  Google Scholar 

  8. Sapsford DJ, Jones JG. The PIO2 vs. SpO2 diagram: a non-invasive measure of pulmonary oxygen exchange. Eur J Anaesthesiol. 1995;12(4):375–86.

    CAS  PubMed  Google Scholar 

  9. Itti E, Nguyen S, Robin F, Desarnaud S, Rosso J, Harf A, et al. Distribution of ventilation/perfusion ratios in pulmonary embolism: an adjunct to the interpretation of ventilation/perfusion lung scans. J Nucl Med. 2002;43(12):1596–602.

    PubMed  Google Scholar 

  10. Rhodes CG, Valind SO, Brudin LH, Wollmer PE, Jones T, Buckingham PD, et al. Quantification of regional V/Q ratios in humans by use of PET. II. Procedure and normal values. J Appl Physiol. 1989;66(4):1905–13.

    CAS  PubMed  Google Scholar 

  11. Poets CF, Samuels MP, Southall DP. Potential role of intrapulmonary shunting in the genesis of hypoxemic episodes in infants and young children. Pediatrics. 1992;90(3):385–91.

    CAS  PubMed  Google Scholar 

  12. Bhutani VK, Rubenstein SD, Shaffer TH. Pressure–volume relationships of tracheae in fetal newborn and adult rabbits. Respir Physiol. 1981;43(3):221–31.

    Article  CAS  PubMed  Google Scholar 

  13. Hoffman J, Heymann M. Normal Pulmonary circulation In: Scarpelli E, editor. Pulmonary Physiology: Fetus, Newborn, Child and Adolescent. 2nd ed. Philadelphia: Lea & Febiger; 1989. pp. 233–56.

    Google Scholar 

  14. Ali K, Rossor T, Bhat R, Wolff K, Hannam S, Rafferty GF, et al. Antenatal substance misuse and smoking and newborn hypoxic challenge response. Arch Dis Child Fetal Neonatal Ed. 2016;101(2):F143–8.

    Article  Google Scholar 

  15. Prechtl HF, Fargel JW, Weinmann HM, Bakker HH. Postures, motility and respiration of low-risk pre-term infants. Dev Med Child Neurol. 1979;21(1):581–90.

    Article  CAS  PubMed  Google Scholar 

  16. Lockwood GG, Fung NL, Jones JG. Evaluation of a computer program for non-invasive determination of pulmonary shunt and ventilation-perfusion mismatch. J Clin Monit Comput. 2014;28(6):581–90.

    Article  PubMed  Google Scholar 

  17. Jones JG, Lockwood GG, Fung N, Lasenby J, Ross-Russell RI, Quine D, et al. Influence of pulmonary factors on pulse oximeter saturation in preterm infants. Arch Dis Child Fetal Neonatal Ed. 2016;101(4):F319–22.

    Article  Google Scholar 

  18. Andropoulos D. Monitoring and Vascular Access. In: Gregory G, Andropoulos D, editors. Gregory’s Pediatric Anesthesia. 5th ed. Oxford: Wiley-Blackwell; 2012. pp. 381–418.

    Google Scholar 

  19. Jopling J, Henry E, Wiedmeier SE, Christensen RD. Reference ranges for hematocrit and blood hemoglobin concentration during the neonatal period: data from a multihospital health care system. Pediatrics. 2009;123(2):e333–7.

    PubMed  Google Scholar 

  20. West J. Pulmonary gas exchange. In: West J, editor. Best and Taylor’s physiological basis of medical practice. Baltimore: Williams & Wilkins; 1991. pp. 546–59.

    Google Scholar 

  21. Sinclair-Smith CC, Emery JL, Gadsdon D, Dinsdale F, Baddeley J. Cartilage in children’s lungs: a quantitative assessment using the right middle lobe. Thorax. 1976;31(1):40–3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Hislop A, Reid L. Fetal and childhood development of the intrapulmonary veins in man–branching pattern and structure. Thorax. 1973;28(3):313–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Gutierrez JA, Duke T, Henning R, South M. Respiratory failure and acute respiratory distress syndrome. In: Taussig LM, Landau LI, editors. Pediatric Respiratory Medicine. 2nd ed. Philadelphia: Mosby Elsevier; 2008. pp. 253–74.

    Chapter  Google Scholar 

  24. Dassios T, Curley A, Krokidis M, Morley C, Ross-Russell R. Correlation of radiographic thoracic area and oxygenation impairment in bronchopulmonary dysplasia. Respir Physiol Neurobiol. 2016;220:40–5.

    Article  PubMed  Google Scholar 

  25. Wagner P. Ventilation-Perfusion Relationships. In: Hamid Q, Shannon J, Martin J, editors. Physiologic Basis of Respiratory Disease. Hamilton: BC Decker Inc; 2005. pp. 165–84.

    Google Scholar 

  26. Poets CF, Stebbens VA, Lang JA, O’Brien LM, Boon AW, Southall DP. Arterial oxygen saturation in healthy term neonates. Eur J Pediatr. 1996;155(3):219–23.

    Article  CAS  PubMed  Google Scholar 

  27. Bard H. The postnatal decline of hemoglobin F synthesis in normal full-term infants. J Clin Invest. 1975;55(2):395–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Bhat RY, Hannam S, Pressler R, Rafferty GF, Peacock JL, Greenough A. Effect of prone and supine position on sleep, apneas, and arousal in preterm infants. Pediatrics. 2006;118(1):101–7.

    Article  PubMed  Google Scholar 

Download references

Funding

The research was supported by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Guy’s and St Thomas’ NHS Foundation Trust and King’s College London. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. Dr Ali was supported by the King’s College Hospital Research Initiative Grant.

Author information

Authors and Affiliations

  1. Neonatal Intensive Care Centre, King’s College Hospital NHS Foundation Trust, 4th Floor Golden Jubilee Wing, Denmark Hill, SE5 9RS, London, UK

    Theodore Dassios & Kamal Ali

  2. Division of Asthma, Allergy and Lung Biology, MRC-Asthma UK Centre in Allergic Mechanisms of Asthma, King’s College London, London, UK

    Thomas Rossor & Anne Greenough

  3. National Institute for Health Research (NIHR) Biomedical Research Centre based at Guy’s and St Thomas’ NHS Foundation Trust and King’s College London, London, UK

    Anne Greenough

Authors
  1. Theodore Dassios
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kamal Ali
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Thomas Rossor
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Anne Greenough
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Theodore Dassios.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Dassios, T., Ali, K., Rossor, T. et al. Ventilation/perfusion ratio and right to left shunt in healthy newborn infants. J Clin Monit Comput 31, 1229–1234 (2017). https://doi.org/10.1007/s10877-016-9969-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10877-016-9969-7

Keywords

Search

Navigation